Talking Therapies for LTC IAPT Physical health and

Talking Therapies for LTC IAPT

Physical health and emotional well-being Emotional well-being and mental health concerns are major health issues in their own right, but they can also greatly affect physical health Having a physical health problem also impacts on mental health Mental illness Physical illness

How mental health affects physical health • Adherence - Physical health patients with depression are three times less likely to adhere to physical health care recommendations than patients without depression • DNA • Lifestyle choices – inactivity, diet, smoking, alcohol, self care • Life expectancy (increased risk of death for depressed patients with heart disease, diabetes and cancer) • Increased Suicide risk- 25. 5% of cases cited a general health related problem 2012 - 2013 suicide audit • NHS cost - £ 8 to £ 13 billion (England) - depression increases costs by 33% to 169% over range of conditions

For contemplation…. “In the case of Type 2 diabetes, £ 1. 8 billion of additional costs can be attributed to poor mental health. Yet fewer than 15 per cent of people with diabetes have access to psychological support”.

IAPT LTC Pilot site outcomes: Cambridgeshire and Peterborough CCG Initial outcomes 61% reduction in A & E attendance in the cohort of patients accessing the integrated IAPT services 73% reduction in GP visits 75% reduction inpatient admissions Berkshire East and West have initial findings: 75% increase in specialist nurse use 49% reduction in GP appointments 52% reduction in A & E attendances 80% reduction in X-Rays Buckinghamshire can demonstrate initial evidence: 57% reduction in Physiotherapy appointments 33% reduction in GP appointments No A & E attendances from cohort completing treatment 50% reduction in admission to hospital Oxfordshire can evidence initial evaluations showing: 76% reduction in days off work due to sickness 33% reduction in Consultant appointments No A & E attendances from cohort completing treatment 100% reduction in admission to hospital

Why change is needed. . • People die younger- • Integration of IAPT is a key part of the 10 Year Plan • Increased cost of care • Improved health outcomes • Improved efficiency of resource

Barriers. . • Stigma – fears of being labelled as being “mentally ill” and this impacting on how they are perceived by family/friends • Healthcare workers, friends and family or patients may not recognise the signs of depression or feel it’s a normal response to the condition • 30 -50% not recognised in consultation • Not knowing where to find the help • Worries that they are a burden • Health care professionals may not feel fully equipped or that they have the time • The separation between mental health and physical health care • Trained to focus on a patient’s physical health

How to ask within tight time frames…. • So you can get ‘just enough’ information to be able to signpost them on to get further support

Summary. . IAPT for LTC…. . • Improves health outcomes • Reduces costs • Reduces GP appointments and A&E/ acute admissions • Supports CCG in reaching access targets

The 5 areas model: Situation/ Trigger Thoughts Physical Symptoms Feelings Behaviours

IAPT Services CBT based Guided Self Help Cognitive Behavioural Therapy tailored for people living with Long Term Conditions, in the form of: § Face to face sessions § Telephone based sessions § Online Therapy (including physical health packages) § Groups Counselling for depression

Who to refer Who • 18+ • Experiencing emotional distress • LTC • Carers • Common mental health problem • Work stress • Not at high risk of suicide • Any existing SMI must be stable • In agreement to referral When • Offer to anyone with an LTC • Refer as soon as you recognise an issue

Guildford & Waverley CCG North West Surrey CCG Surrey Downs CCG Guildford, Godalming, Haslemere, Milford, Chiddingfold, Hindhead Worplesdon, East Horsley & Cranleigh Ashford, Walton, Chobham, Weybridge, Woking, West Byfleet, Shepperton, Chertsey, Addlestone, Egham, Stanwell, Staines, Virginia Water & Pirbright, Tadworth, Dorking, Leatherhead, Thames Ditton, East Molesey, Ashtead, Epsom, Worcester Park, Ewell, Stoneleigh, Esher, Banstead, Oxshott, Brockham, Newdigate, Claygate, Bookham & East Molesey Centre for Psychology 01483 570 765 DHC- NHS Talking Therapies 01306 735473 or www. dhcclinical. com/iapt. php IESO Digital Health 01954 230066 or www. iesohealth. com/surr ey Mind Matters- NHS 0300 330 5450 www. mindmattersnhs. co. uk/surrey Think. Action Woking 03000 12 www. thinkaction. org. uk Text TALK to 82085 03000 12 DHC Talking Therapies 01483 906392 or www. dhcclinical. com/iapt. php IESO Digital Health 01954 230066 or www. iesohealth. com/surr ey Mind Matters NHS 0300 330 5450 www. mindmattersnhs. co. uk/surrey Talking Therapies Surrey Online 0300 365 2000 or www. berkshirehealthcare. nhs. uk/surreyonline Think. Action Woking 03000 12 www. thinkaction. org. uk Centre for Psychology 01483 570 765 DHC- NHS Talking Therapies 01483 906392 or www. dhcclinical. com/iapt. php IESO Digital Health 01954 230 066 or www. iesohealth. com/surr ey Mind Matters- NHS 0300 330 5450 www. mindmattersnhs. co. uk/surrey Think. Action 03000 12 www. thinkaction. org. uk East Surrey CCG Surrey Heath CCG Redhill, Merstham, Reigate, Caterham, Warlingham, Horley, Whyteleafe, Lingfielf, Oxted & Godstone, Ash Vale, Camberley, Frimley, Lightwater & Bagshot DHC- NHS talking therapies 01306 735473 or www. dhcclinical. com/iapt. php IESO Digital Health 01954 230066 or www. iesohealth. com/surr ey Mind Matters- NHS 0300 330 5450 www. mindmattersnhs. co. uk/surrey Think. Action 03000 12 www. thinkaction. org. uk Text TALK to 82085 Centre for Psychology 01276 423 141 IESO Digital Health 01954 230066 or www. iesohealth. com/surr ey Mind Matters-NHS 0300 330 5450 www. mindmattersnhs. co. uk/surrey Think. Action 03000 12 www. thinkaction. org. uk Text TALK to 82085 Farnham and NE Hants CCG Farnham only Talk Plus Centre for Psychology 01483 570 765 01252 533355 www. talkplus. org. uk/

Suggested next steps? 1. Routinely Consider IAPT for all LTC clients and ensure IAPT resources are available 2. Consider integration of PHQ 4 in review templates 3. Consider opportunities for co-location

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